Published in Panorama
Coping with Menopause
48 year old Reema has been having disturbed sleep now for some months. She frequently wakes up at night, feeling intense heat all over her body with considerable sweating. On consulting her family physician, she was told that she was perhaps, nearing menopause.
Menopause, explains Dr.Saleena Moiddin Kutty, Gynaecologist and Obstetrician, Dr.Moopen’s Poly Clinic Deira, “is a natural part of aging and occurs when the ovaries stop making the estrogen hormones. The average age when a women attains menopause is around 51 years, though it is not uncommon to see young girls of 17 years or thereabout having menopause as a result of disease like leukemia where she is undergoing chemotherapy. Also, some women may attain menopause before 35 years of age, when for some unknown reason, their ovaries stop functioning, or are surgically removed.”
The symptoms leading to menopause which is the actual cessation of menstrual bleeding, begins at least two to three years earlier and is called peri menopause or climacteric. Dr.Saleen explains, “It is not something that happens in one day; it is a process which takes time to finally culminate in the cessation of menstrual bleeding. This is the period when the woman slowly starts getting the symptoms and for most women, it begins with irregularity of the periods. The periods may be of shorter or longer duration, heavier or scanty bleeding, and varying lengths of time between periods”.
Hot flushes are the classic sign of menopause and often, some women may feel as if their body was on fire, reveals Dr.Saleena. “These hot flushes may last only for a few seconds to several minutes but some people may not be able to tolerate the physical distress from this and they start sweating, especially at night. Some women have hot flashes for several years before menopause, and some have them for several years even after menopause.”
Dr.Sanjay Khanna, Psychiatrist, Zulekha Hospital, Sharjah, adds, “These hot flushes may be especially felt on the hands, arms and chest and could even last for up to one or two hours. Other peri menopausal symptoms include mood swings, anxiety, depression, irritability, lethargy, lack of concentration and loss of memory, fast and hard heart beats or palpitation, lack of concentration, lethargy, lack of motivation and energy and insomnia, reveal the doctors.”
Apart from these symptoms which chiefly relate to the emotions and psyche of the patient, the physical symptoms could include wrinkling of the skin, vaginal dryness, discomfort and itching, loss of libido, urinary stress incontinence and dribbling of the urine, explain the doctors.
While the symptoms of menopause last for a relatively short time, the low estrogen levels can have far reaching consequences for the women from the long term point of view, admits Dr.Saleena. “These chronic symptoms associated with menopause are more dangerous and can affect the life of the women. These problems include osteoporosis, increased risk for heart disease, increased risk of embolism and stroke, deep vein thrombosis, enhanced risk of certain types of cancer, particularly breast & uterine cancers and Alzheimer’s Disease”.
Estrogen stimulates skeletal growth and helps maintain healthy bones. Similarly, it also has protective effect on the heart and veins in that it increases the 'good cholesterol' or or high-density lipoprotein (HDL) and lowers 'bad cholesterol' which is the low-density lipoprotein (LDL). Dr.Saleena explains, “If your bone mass is more, the incidence of osteoporosis is less. And as a natural ageing process, bone mass is likely to be less in both men and women. But women lose bone more rapidly after menopause and this may make them more prone to fractures, particularly of the hips. Again, estrogen is important in maintaining the functions of the vagina, surrounding tissues and the urinary tract. Following menopause, all these organs weaken or shrink, leading to genital atrophy and attending urinary symptoms.”
What is the role of Hormone Replacement Therapy (HRT) in women who have attained menopause? Dr.Saleena is candid as she explains, “HRT is a controversial issue where the benefits from it have to be weighed against the risks, since the therapy is not free of risks. There is no doubt that HRT slows the rate of bone thinning and prevents bones from breaking which result from osteoporosis. Similarly, studies have proved that the incidence of heart disease is also substantially reduced by lowering high levels of LDLwith HRT. HRT is believed to have beneficial effect on blood pressure and blood sugar levels besides preserving brain activity and improving memory and Alzheimer’s Disease. Even the vasomotor symptoms like the hot flushes, respond to HRT. But the risks from HRT cannot be ignored and these include making a woman more prone for breast and uterine cancer. In some cases, the embolic episodes come more when you take supplementary estrogen! So you have to balance the risks vis-à-vis the benefits because some people, hereditarily are prone for such problems and HRT further adds to the problem.”
However, there are alternative therapies which do not suffer from the negative effects of HRT, says Dr.Saleena. These include taking vitamin D and calcium supplements. Summing up the coping measures, Dr.Saleena emphasizes, “Physical changes do occur with menopause and with aging. But the changes that happen during this period can be minimized by healthy living, by eating right, exercising right, and making positive lifestyle changes in an attempt to lead a purposeful life. Women can prepare for this change, very early in life. For instance, after pregnancy and lactation, they should supplement the body with calcium adequately by taking dairy products, green vegetables and foods rich in calcium. Regular weight-bearing exercise like walking, definitely increase bone mass and may therefore help prevent osteoporosis.”
Dr.Sanjay Khanna emphasizes the psychological aspects of dealing with this important turning point in a woman’s life. “We teach the women relaxation exercises and techniques related to yoga and meditation and stress reduction. Most women respond to these measures. However, some women may have more than mild symptoms for whom we advocate counseling and psychotherapy. We take recourse to anti-depressants when all these measures fail, as may happen in very few cases. However, what helps most, is the support system that the women get from their surrounding environment, from the home and family in particular. Family members, particularly the husband and children must realize that she is going through an important phase in her life and should make her feel loved and wanted. Though the major problems associated with menopause are due to the hormonal changes, harassing family atmosphere, strained family relationships can and do aggravate symptoms of anxiety and depression which are normally present in the peri menopausal stage.”